Education Committee Highlights WGC-2019 – part 13

The Education Committee carefully selects presentations from the WGC-2019 for your benefit. This month Sola Olawoye introduces the sessions: Glaucoma Australia Patient Symposium and Grand Rounds.

Glaucoma Australia Patient Symposium

This symposium was anchored by Glaucoma Australia. It explored how patients and Ophthalmologists can be united by their interests in glaucoma. The passion of the glaucoma Australia patient symposium is to improve awareness and ensure early diagnosis of glaucoma in Australia.

Professor Ivan Goldberg in his opening remarks discussed in simple terms how glaucoma affects the optic nerve. Glaucoma is the commonest cause of irreversible blindness worldwide, often progressive, often asymptomatic until later stages and treatment is lifelong but effective. He highlighted the importance of adherence to medications and clinic visits. He also emphasized the importance of patients and their ophthalmologists forming a strong therapeutic alliance towards preventing glaucoma blindness. He concluded his remarks by highlighting the importance of patient-centered approach in glaucoma management.

Lab based research

Professor Paul Healey discussed how research has greatly improved our understanding of glaucoma. He described glaucoma as one of the most highly heritable diseases. Certain genetic variations have been found in high proportion of glaucoma patients but some of these genes have also been found in normal persons who do not have glaucoma. Polygenic risk scores may be important in determining who will develop glaucoma. This score can add up the risks associated with the presence of multiple genes that have been identified in glaucoma patients. He also discussed gene therapy strategies and concluded that the future of genetic therapy is likely pharmaceutical in which treatment can be personalized.

Clinical advances

Professor Simon Skalicky discussed two equally important concepts in caring for glaucoma patients which are monitoring and treatment. Monitoring involves regular intraocular pressure check and tests of the optic nerve head and field of vision, while treatment involves lowering the intraocular pressure with medications, surgery or lasers. He highlighted the important improvements in clinical practice over the years such as a faster, more user friendly visual field testing and an array of available micro-stents. These stents are a great option in patients with stable glaucoma who need cataract surgery. He concluded that there have been several advancements in glaucoma care over the years and it is important for clinicians to bring these improvements to the clinic setting where they can be beneficial to patients.

Glaucoma Australia Patient support

Annie Gibbins discussed the mission of the glaucoma Australia patients support program. She said there were about 10,000 persons in Australia who are blind from glaucoma. About 300,000 have glaucoma but 50% of these (150,000) remain undiagnosed. The patient support group has a mission to reach out to these undiagnosed persons by creating awareness and ensuring early diagnosis by screening for glaucoma.  Studies show that at 12 months of diagnosis, glaucoma patients use their eye drops properly only 36-50% of the time. One of the goals of the patient support group is to ensure that patients use their medications appropriately all the time.

Apps and Aids to assist patients

Grant Wilson works at Vision Australia and he discussed the apps and aids for persons with visual impairment. Vision Australia supports about 25,000 people with visual impairment in Australia. He described several gadgets and cameras, speakers that can be clipped on the arm of glasses or on phones which are very helpful for persons with visual impairment.

He concluded that keeping in touch with Glaucoma Australia and Vision Australia can help in sustaining the independence and confidence of persons with visual impairment.

Watch the presentations

Grand Rounds

Bilateral Cystoid Macular Oedema following SLT both eyes

Dr. Pankaj Bankale discussed a patient with primary angle closure glaucoma and cataracts in both eyes with intraocular pressures of 24mmHg and 26 mmHg in the right and left eyes respectively. Patient had bilateral phacoemulsification and after 3 months his intraocular pressures were 18mmHg and 19mmHg in the right and left eyes respectively. He had Selective Laser Trabeculoplasty (SLT) in both eyes. However, two weeks afterwards, he presented with reduced vision and was found to have Cystoid Macular Edema (CME) in both eyes. The patient was given Ranibizumab (Lucentis) and he responded very well with markedly improved vision.

‘A sticky situation’ – vitreous occlusion of tube of a glaucoma drainage implant

Dr Mei Ling-Chen presented a 36 year old aphakic who was pregnant with her 3rd child and presented with reduced vision of 6/18 in her better eye. She had a past medical history of juvenile idiopathic arthritis and chronic uveitis which led to secondary glaucoma. She had bilateral Baerveldts shunts in 2010 but recently presented with a raised IOP of 36 mmHg in the better eye. On examination she had a peaked pupil, shallow bleb and a CDR of 0.9 and she had vitreous tracking into her tube shunt device. She underwent surgery under general anaesthesia and had anterior vitrectomy with complete removal of the vitreous wick. Patient had good postoperative outcome and achieved a vision of 6/9 in the better eye. Her IOP reduced to 10mmHg at 6 months.

Unusual case of pupillary block sixteen years after phacoemulsification: A diagnostic challenge

Dr. Natasha Gautam Seth presented a 75-year-old female with sudden onset painful right eye, redness and deterioration in vision. She had cataract surgery in the right eye 16 years ago and in the left eye 8 years with good vision post operatively. There was no posterior capsular rent.  Her IOP was 46mmHg in the right eye and she was commenced on anti-glaucoma medications. She had uniformly shallow anterior chambers with fixed mid dilated and poorly reacting pupil. She had a hazy media but the disc was normal. A diagnosis of acute unilateral IOP rise 16 years after phacoemulsification was made in the right eye. This is a rare occurrence after phacoemulsification. Patient had peripheral iridotomy with limited posterior and anterior vitrectomy.  At surgery patient was noted to have zonular dehiscence with leakage of vitreous into the posterior chamber which might have led to angle closure. Post operatively vision improved to 6/9 and her IOP was controlled at 12mmHg.

A case report of secondary angle closure glaucoma with microspherophakia in a young female.

Dr Sunitha Gowda presented a case of secondary angle closure glaucoma with microsherophakia in a young 25-year-old female. The patient presented with gradual painful deterioration of vision in the right eye. She had a visual acuity of hand motion, shallow anterior chamber in both eyes with IOP of 52 mmHg in the right eye and 20 mmHg in the left eye. Gonioscopy revealed a 360 degree synechial angle closure in both eyes. A diagnosis of angle closure glaucoma with microspherophakia was made. She had clear corneal phacoemulsification and trabeculectomy in the right eye and postoperatively her IOP was 12mmHg without adjunct medications.

Case of Acquired Aniridia with raised intraocular pressure and absent retinal circulation

Dr. Kedarisetti Kiran Chandra presented a case of acquired aniridia with raised intraocular pressure and absent retinal circulation in a 23-year-old patient. The patient was diagnosed with glaucoma with high intraocular pressure. Her gonioscopy showed open angles with prominent iris processes in the right eye. In the left eye she had hypoplastic ciliary body with no visible iris tissue.  There was deep cupping and total absence of retinal circulation in the left eye. A diagnosis of acquired aniridia with raised intraocular pressure and absent retinal circulation was made in the left eye.

Unilateral Open Angle Glaucoma in an adult with large corneas

Dr Marc Alfred Mangahas presented a 29-year-old patient with unilateral open angle glaucoma in an adult with bilateral large corneas. He had one-year history of intermittent blurring of vision in both eyes. He also had significant loss of vision in the right eye with IOP of 56 mmHg.  He had RAPD, bilateral phacodenesis and iridodenesis with bilateral open angles. A diagnosis of unilateral open angle glaucoma with bilateral large corneas was made.

Watch the presentations